The report found the U.S. spent $9,364 per person on healthcare in 2016, compared to only $4,094 in the U.K., which ranked first on performance overall. Other top performers were Australia and the Netherlands.

The study authors found that the U.S. substantially lags behind other countries on access to care, primary care and affordability. It ranks last for equity, administrative efficiency and outcomes and provides the least financial protection for its citizens among the countries studied.

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Commonwealth Fund President Dr. David Blumenthal said the report shows that the U.S. healthcare system is still not working as well as it could for Americans, despite coverage and access gains made from the Affordable Care Act (ACA). The health reform proposals on Capitol Hill would make the issue even worse, he said.

The U.S. has ranked last in the six similar reports since 2004. Of the 11 high-income countries surveyed, the U.S. is the only one without universal health insurance coverage.

The study, which used survey data that measured and compared patient and physician experiences, found 44% of lower income people in the U.S. and 26% of higher income people in the country reported financial barriers to care. In the U.K. only 7% with lower incomes and 4% with higher incomes reported that costs prevented them from getting healthcare. Those figures reveal that a high-income American is more likely to report financial barriers than a low-income person in the U.K.

Most everyone agrees there are serious problems with the U.S. healthcare system. However, leaders can’t agree on how it should be fixed. Republicans in Congress are working feverishly to repeal the ACA. The bills currently being considered would lead to millions losing health insurance, according to the Congressional Budget Office.

On the other extreme of the healthcare issue are leaders like Sen. Bernie Sanders (I-Vt.), who proposes a single-payer Medicare for All healthcare system that would provide universal access.

In announcing the new study’s findings on Friday, Commonwealth Fund Senior Vice President and Researcher Dr. Eric Schneider provided some thoughts on how the county can improve: Expand health insurance, such as following the other wealthy nations and providing universal coverage; invest more in primary care and provide those services on nights and weekends; reduce paperwork for patients, caregivers and physicians; and invest more in social services to reduce disparities that come from differences in housing, education, nutrition and transportation, which all have a “substantial effect on people’s health.”

“A country that spends as much as we do could be the best in the world," he said. "We can adapt what works in other countries and build on our own strengths to achieve a healthcare system that provides affordable, high-quality healthcare for everyone.”